Smart Reads: Judy Melinek’s ‘Working Stiff’

Forensic pathologist Judy Melinek uncovered the last chapters in the stories of New Yorkers killed by accidents, mysterious illnesses, terrorist attacks, and other strange circumstances during her tenure at the city’s medical examiner office. We got a chance to chat with Melinek recently about her new book (coauthored with her husband, T.J. Mitchell), Working Stiff, which offers a probing glimpse of the ways we die—the messy and mundane—with plenty of fascinating (and sometimes gory) details about the art of autopsies:

(Note: This interview has been lightly edited for clarity and length.)

WSF: What makes a good medical examiner?

JM: To begin with, you need good diagnostic skills; you need to be a good doctor. In order to be a forensic pathologist, you need to have a basic understanding of all of medicine, and that includes anatomy, physiology, and the subspecialties, because everybody dies at different ages and stages.

You need to know pediatrics because children occasionally die; you need to know obstetrics and gynecology because pregnant women die; and you need to know geriatrics because the elderly die. You have to know trauma and trauma surgery because people who had traumatic injuries that come to the coroner or medical examiner’s office will have had surgery, so you need to know all the major surgical procedures and how those could also contribute to your death. And you have to have the training of anatomic and clinical pathology before you even start: learning how to perform hospital autopsies in patients who have diagnosed diseases, and also surgical pathology, which is looking at organs taken out in surgery, and laboratory medicine.

WSF: When you were working in NYC, what was the most common cause of death that ended up on your table?

JM: It was probably an equal mix of accidents, overdoses, and natural deaths. Many were just people who were found dead in their apartment and had no medical history or were found dead on the street and we didn’t know who they were. A large chunk were things like industrial accidents, falls, and suicides. Homicides are a minority; they’re about 10 percent of a forensic practice in most cases.

WSF: What cases are the most difficult to crack?

JM: The ones that are most challenging to me are the medical problems, what we call “therapeutic complications” in New York; “medical misadventures” is what they were called in Los Angeles.

There was one case where a man had had surgery, and afterwards he started bleeding in his neck. The surgeon claimed that the suture broke; the debate was whether it broke or wasn’t tied properly in the first place. So we extensively examined that area, including even using an electron microscope to look at the tips of the sutures and answer that question.

Homicides, by contrast, are pretty straightforward. A bullet goes in, a bullet comes out; there’s no mystery.

WSF: What did you like most about being a medical examiner?

JM: Every day is a surprise, every day is a challenge, every day I’m learning something new. The emotional satisfaction comes from being able to actually help families. One thing that pathologists in hospitals lose track of is direct patient contact; most will work in the laboratory and will just be interacting with other doctors. In forensics, a large part of the job is interacting with family members.

Check out this excerpt from the book below, where Melinek is examining a victim who fell to his death from the upper story of a building

You might imagine that the remains of a human body that had fallen a hundred feet and landed on a city sidewalk would be a gruesome sight, but that’s often not the case. Not on the outside, at least. The gruesome is on the inside. Jerry wasn’t very bloody and didn’t look battered—but his heart was sheared in half, his liver torn up. Pieces of his right rib cage had scissored through both lungs, leaving them ratty and full of blood, and his airway was coated in soot from smoke inhalation.

After I’d removed Jerry’s mangled organs from his trunk, I was able to examine the blood vessels, bones, and muscles beneath. I started with the biggest artery and vein, the aorta and the inferior vena cava, disconnecting them from the inner surface of the spine. I inspected them carefully for ruptures but didn’t find any, so I deposited the whole dangling fork of tubules down at the foot of the autopsy table with the organs, and took a good look at Jerry’s spinal column from the inside. No fractures or bleeding. He hadn’t broken his back when he landed.

He’d broken his pelvis, though—grievously. I could tell as much without even seeing the bones. When I wiggled Jerry’s hips, they felt—and sounded—like a bag of marbles. I cut away the ileacus and the psoas, the two big muscles of the inner hip, and found beneath them a mess of fragmented bone on the right side, corresponding to the contusions on Jerry’s right hip. He’d landed there and smashed the stout pelvic girdle to bits.

Excerpted from Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner by Judy Melinek, MD and T.J. Mitchell. Copyright © 2014 by Dr. Judy Melinek and Thomas J. Mitchell. Reprinted by Permission of Scribner, a Division of Simon & Schuster, Inc.